Organization
CENTRAL UTAH CLINIC, P.C.
Active
Other names
Revere Health
Organization subpart
No
Provider details
NPI number
Authorized official
JED HARSTON (DIRECTOR OF MANAGED CARE)
(801) 812-5012
Entity
Organization
Contact information
Practice address
97 S PROFESSIONAL WAY, SUITE 2, PAYSON, UT 84651-1614
(801) 465-4896
(801) 465-4107
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870609595000
—
UT
Enumeration date
07/03/2006
Last updated
03/07/2018
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